verifying significant improvements in pain and functions without significant risks or harm. An additional PEG test should be conducted, and patients should also be evaluated for risk of harm or misuse, and signs of over-sedation or overdose risk.
Physicians should determine whether to continue, adjust, taper or simply stop prescribing drugs during these reassessments. And if there is any indication of difficulty controlling its use, addiction treatment should be immediately referred.
Recognizing the risk of opioid addiction before prescribing
The CDC also points out effective ways for physicians to recognize opioid addiction, which consists of the three “C’s”:
- Loss of control: This can be hinted by reports of lost or stolen medications, calls for early refills, noted withdrawal symptoms, or interest in receiving opioids from other sources.
- Cravings: The patient may be preoccupied with the use of drugs, frequently asking for an increased prescription allowance, dismissive of non-opioid treatments, and claims of increased pain with no signs of the disease worsening.
- Use despite negative consequences: A patient may over-sedate and decrease in activity, functioning and/or relationships.
Doctors should ensure that patients have a low likelihood of having an addictive disease by screening them prior to prescribing opiates, Gitlow said.
“Make sure that they don’t have a family history of addiction, make sure that they don’t have a personal history of addiction to any substance — and if they don’t, then your chances of being able to give them an opiate will have no separate consequences while they improve.”
Don’t believe the hype
Instant gratification is one of the main reasons patients in the U.S. are so quick to use opioids to relieve pain, according to Gitlow.
“All they do is take somebody’s mind away for a little while, and they can ignore the underlying problem,” he said. “Those kinds of solutions generally have repercussions as the drug is used over an extended period of time, and a person grows tolerant. Their perception of pain actually worsens as times passes rather than improves. Ultimately not a great idea.”
But there are situations when opiates are the appropriate route, especially for short-term pain and cancer patients, Gitlow said “If you’ve got cancer or cancer-related pain, then opiates are indicated. Opiates can be helpful with that. If you have acute pain — in other words, pain that’s likely to last two or three days; post surgical pain for instance — opioids are indicated for that as well. Those are the two instances where opioids can be helpful.”
However, there have been no scientific studies to ever demonstrate the benefits of opiates and long-term chronic pain, he said. “That’s sort of the surprising thing when you tell people that … they simply have never been shown to work.”
